Positive Behavioural Support Competence Framework May 2015

Positive Behavioural Support
A Competence Framework
Positive Behavioural Support (PBS)

Coalition UK
May 2015
The Positive Behavioural Support Competence Framework has been produced by the PBS Coalition - a collective of individuals and
organisations promoting PBS in the UK. The Framework is licensed under a Creative Commons Attribution-ShareAlike 4.0
International License.
All organisations and individuals are welcome to use the PBS Competence Framework and to remix, tweak, and build upon the
content even for commercial purposes, as long as they credit the PBS Competence Framework and the work of the PBS Coalition
and license their new work under the identical terms.
The Framework is available on the PBS Academy website: www.pbsacademy.org.uk
We are delighted that the PBS Competence Framework has been endorsed by the following organisations. Whilst this does not
imply that each organisation is necessarily demonstrating all of the competencies required of quality provision as outlined in the
framework, our expectation is that this suggests a commitment to its implementation.
2
PBS Competence Framework 2015
3
Impact Effeithio
Challenging Behaviour Cymuned Ymarfer
Change Newid
Community of Practice Ymddygiad Heriol
Inform Rhoi Gwybod
4
Contents
What is Positive Behavioural Support (PBS)? 6
Why use PBS? 10
When and for whom might PBS assessment and intervention plans be needed? 11
How is PBS implemented? 12
What is the PBS Competence Framework? 13
The PBS Competence Framework
Creating high quality care and support environments 20

Functional, contextual and skills based assessment 39
Developing and implementing a Behaviour Support Plan (BSP) & 49
Evaluating intervention effects and on-going monitoring
References 67
Acknowledgements 72
5
What is Positive Behavioural Support?
Over the last three decades, Positive Behavioural Support (PBS) has increasingly become the model of choice in supporting people
whose behaviour poses challenges to services. While there are a number of existing descriptions of PBS available (Allen et al., 2005;
Carr et al., 2002; Horner et al., 1990, 2000; LaVigna & Willis, 2005), a recent definition by Gore et al., (2013) sought to bring
together the fundamental elements of PBS in a way that could usefully inform future service, policy and research developments in
the UK. The key features of this definition are summarised in Table 1.
Gore and colleagues emphasise that PBS is a multicomponent framework for developing an understanding of behaviour that
challenges rather than a single therapeutic approach, treatment or philosophy. It is based on the assessment of the broad social
and physical context in which the behaviour occurs, and used to construct socially valid interventions which enhance quality of life
outcomes for both the person themselves and their carers.
The framework consists of ten elements grouped into three overarching themes of values, theory/evidence base, and process. It is
important to stress that these elements do not represent a ‘menu’ of options. Rather, the effective implementation of PBS
necessitates the combined use of all of these elements.
Values
PBS combines the technology of behavioural intervention with the values of normalisation, human rights, and self–determination
to deliver effective person-centred support for people whose behaviour challenges. Crucially, these values inform both the way in
which this technology is used and the outcomes that it is designed to achieve.
PBS, therefore, aims to enhance quality of life as both an intervention and outcome for people who display behaviour that
challenges and those who support them. PBS interventions are also constructional in that increasing the person’s repertoire of
adaptive behaviours and their range of positive life opportunities is a central objective. In contrast, the use of aversive or punitive
interventions is rejected on the basis of their incompatibility with a values-led approach.
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Table 1: Key Components of PBS
1. Prevention and reduction of challenging behaviour occurs within the context of increased
quality of life, inclusion, participation, and the defence and support of valued social roles
Values
2. Constructional approaches to intervention design build stakeholder skills and opportunities
and reject aversive and restrictive practices
3. Stakeholder participation informs, implements and validates assessment and intervention
practices
4. An understanding that challenging behaviour develops to serve important functions for
people
Theory and
Evidence Base 5. The primary use of constructional principles and procedures from behaviour analysis to
assess and support behaviour change
6. The secondary use of other complementary, evidence-based approaches to support
behaviour change at multiple levels of a system
7. A data-driven approach to decision making at every stage
Process 8. Functional assessment to inform function-based intervention
9. Multicomponent interventions to change behaviour (proactively) and manage behaviour
(reactively)
10.Implementation support, monitoring and evaluation of interventions over the long term
Gore, N.J., McGill, P., Toogood, S., Allen, D., Hughes, J.C., Baker, P., Hastings, R.P., Noone, S.J. & Denne, L.D. (2013). Definition and scope for positive behavioural support.
International Journal of Positive Behavioural Support, 3 (2), 14-23
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PBS takes account of the behaviour and wellbeing of stakeholders (such as paid and family carers) and emphasises stakeholder
participation to ensure that assessments, interventions, and outcomes are meaningful. PBS is therefore ‘done with’ rather than
‘done to’ the person and those who support them.
Theory and Evidence Base
PBS is founded upon an understanding that behaviours that challenge serve important functions for those who display them. They
develop and are maintained within the context of a person’s abilities, needs (including their physical and mental health) and
circumstances and, critically, the characteristics of the social and physical environment within which the behaviour occurs. These
environments often contain or lack important features that are provocative of behavioural challenges, and the term ‘challenging
environments’ has been used to stress that many of the causal factors behind such behaviours lie outside the person.
This understanding, together with many of the assessment and intervention methods utilised in PBS, is grounded in constructional
principles and procedures from behaviour analysis.
PBS is also an inclusive approach which incorporates additional evidence-based approaches that are supportive of its stated values
and compatible with its overarching framework.
Process
PBS requires assessment and support arrangements to be personalised and grounded directly in information that has been
gathered about the person (including their broader needs and abilities) and their environment.
The PBS process begins with a systematic assessment of when, where, how and why an individual displays behaviour that
challenges, a process known as functional assessment or functional analysis. The primary outcomes of this process are1:
1. A clear description of the behaviours of concern (including classes or sequences of behaviour that occur together).
1
from O’Neill et al., 1997
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2. The identification of the events, times, and situations that predict when the behaviour will and will not occur across the
person’s full range of typical daily routines.
3. Identification of the consequences that maintain the behaviour (that is, the purposes or functions that the behaviour
appears to serve for the person)
4. The development of one or more summary statements or hypotheses that describe specific behaviours, the situations in
which it occurs, and the consequences that may maintain it.
5. The collection of direct observational data that support the summary statements that have been developed.
Reflecting the fact that behaviours that challenge often have multiple causative factors, PBS intervention plans typically have multi-
components which are built on the findings of assessment and devised in partnership with key stakeholders. Proactive strategies
that seek to reduce the likelihood of behaviours of concern occurring should form the majority of any plan. These will include
interventions aimed at increasing stakeholder quality of life, ones that seek to alter the contexts in which challenging behaviours
occur, and those which support the development of new skills that serve the same function as the behaviour or which enable the
person to cope more effectively with situations that they find hard to manage.
A PBS plan will also describe an appropriate and ethical range of reactive strategies to guide responses to incidents of behaviour
that are not preventable and which aim to minimise escalation and reduce the risk of harm to the person and others. These should
form a minority component of any plan, but play a crucial role in terms of making people safe.
Finally, PBS plans provide guidance on how strategies will be implemented, by whom and by when. Data-based systems are
required to monitor both the reliability of plan implementation and resulting changes in quality of life and behaviours that
challenge.
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Why use PBS?
There are four main reasons to recommend PBS as an approach to support individuals whose behaviour challenges:
 PBS has been developing within a variety of settings in the UK over the past three decades, and there is now a strong practice
base for its use.
 The values underpinning PBS are entirely congruent with those within national policy and frameworks for people with
intellectual disability.
 There is a strong scientific evidence base for the technology that underpins PBS. Practitioner-researchers have been using
single case experimental designs to evaluate intervention effectiveness for several decades. These have in turn been subject
to a number of systematic reviews and meta-analyses (Campbell, 2003; Carr et al., 1990, 1999; Didden et al., 1997; 2006;
Harvey et al., 2009; Marquis et al., 2000; Scotti et al., 1991). The most recent of these (Heyvaert et al., 2010, 2012) included
over 250 single case design studies and confirmed that behavioural interventions deliver positive outcomes for individuals
whose behaviour challenges. There is also limited randomised controlled trial (RCT) evidence which attests to the efficacy of
PBS. One UK study in which individuals were allocated randomly to receive PBS delivered by a specialist team or input as
usual showed significantly better outcomes for those allocated to the PBS arm of the trial (Hassiotis et al., 2009). Data were
also reported which suggested that the PBS support cost slightly less overall to deliver (due to reduced use of other health
services by the participants).
 PBS is recommended as best practice within professional practice documents (Royal College of Psychiatrists, British
Psychological Society & Royal College of Speech & Language Therapists, 2007) and in national policy statements. In England,
for example, this includes Meeting Needs and Reducing Stress (NHS Protect, 2013) Positive and Proactive Care (Department
of Health, 2014), Ensuring Quality Services (Local Government Association and NHS England, 2014) and A Positive and
Proactive Workforce (Department of Health, Skills for Health & Skills for Care, 2014), all of which champion the role of PBS in
providing effective support to people who challenge. In Wales the PBS is a key recommendation in the Welsh government
report by the Learning Disability Advisory Group and All Wales Challenging Behaviour Community of Practice entitled
‘Transforming care for people in Wales with a learning disability and challenging behaviour: The five top priorities.’
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When, and for whom, might PBS assessment and intervention plans be needed?
The aim should always be to produce a functional assessment and accompanying Behaviour Support Plan (BSP) for challenging
behaviour, irrespective of its severity or chronicity. The complexity and intensity of that assessment and plan will however vary
with the complexity and intensity of behavioural challenge and should therefore follow an incremental approach.
A pre-assessment that involves gathering data which helps shape the initial focus and level of any assessment work should always
be completed. Key information may be provided in referral forms or letters, but will typically need supplemented by obtaining
further details from the referring agent and key carers.
For recent onset or low level behaviours, simple forms of functional behavioural assessment may be sufficient to identify
relationships between the behaviour, antecedents and its consequences. Where there are behaviours of recent onset or marked
changes in patterns of existing behaviours, the contribution of any significant alterations in environment, physical or psychological
health must be explored and appropriate interventions implemented.
For more established and complex behaviours, or behaviours that do not respond to lower levels of assessment and intervention,
more in-depth assessment involving combinations of informant interviews, direct observations, structured record keeping,
questionnaires and reviews of case material will be required.
Irrespective of the level of assessment, the person’s key carers and, whenever possible, the person themselves, should be fully
involved in the process and in sense checking its outcomes.
Assessment of more complex behaviours should always be multi-disciplinary. The resulting formulation should be likewise with
one, single account of why the behaviours are occurring being produced (as opposed to individual, uncollated professional
opinions). The formulation should integrate findings about the person, their environment and behaviour into a coherent and
dynamic whole. Assessment should also involve an analysis of the strengths and needs of the person’s carers (for example, the
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resources they have available, their existing knowledge, attitudes towards the person, their current beliefs about the behaviour,
and any significant health or personal concerns).
Where the behaviour poses risk to the person or others, an appropriate risk assessment should also be completed.
Assessment should always include a baseline measure of current behavioural rate and intensity so that repeated measurements
can be taken post-intervention to gauge change. Assessment should also involve baseline measures of quality of life and current
usage of restrictive practices (such as physical restraint, as required medication, or seclusion). Assessment should be a dynamic
rather than static process because precipitating and maintaining variables may change over time. Repeat assessments should
always follow any change in presentation of a person’s behavioural challenges.
How is PBS implemented?
PBS may be implemented in at least three ways:

 By a single practitioner coordinating all elements of the framework and leading each stage of the process on a
case-by-case basis.
 In team partnerships between a range of professionals and a person’s regular carers.
 Through system-wide approaches whereby the PBS framework is implemented at varying levels or tiers of
intensity across an entire organisation (such as schools, residential or small group homes, or specialist inpatient
settings) or geographical territory.
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What is the PBS Competence Framework?
While the emphasis on PBS in UK policy is welcome, its main impact to date is that many services, agencies and trainers now lay
claim to implementing this approach when their actual practice bears little or no resemblance to the model described above. This
parallels experience in North America, where a similarly rapid promotion of PBS was associated with a misunderstanding, dilution
and corruption of the approach.
The genuine implementation of PBS requires joined-up working across service sectors and within multi-disciplinary teams, ensuring
that both teams and the individuals within them understand their role in delivering this approach. It also requires the recruitment
and retention of the right people, quality training and staff development, opportunities for staff progression within services, the
ability to assess staff performance and evaluate service provision, knowing what to look for in a service provider, and consistency in
practice to facilitate research. Mapping these components against a shared framework of peer-reviewed competencies is one way
of supporting such joined-up working (Denne et al., 2013).
The UK PBS Competence Framework therefore provides a detailed framework of the things that you need to know and the
things that you need to do when delivering best practice PBS to persons with intellectual disabilities and behaviours that
challenge. The objectives of the framework are that:
 More individuals with intellectual disabilities and behaviours that challenge will benefit from high-quality, evidence-based
support delivered by competent professionals working as part of a multi-disciplinary team.
 Practitioners will benefit from professional development and occupational standards.
 Organisations supporting individuals with intellectual disabilities and behaviours that challenge will be able to employ
practitioners with a greater degree of certainty about competence and quality.
 Commissioners will have a greater understanding of the nature and use of PBS in practice.
 Practice based research will contribute to the growing evidence base for PBS.
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Who is the framework for?
The UK PBS Competence Framework is for any individual providing or procuring direct support or working with persons with
intellectual disabilities and behaviours that challenge, as well as any health, education or social care professional, service provider,
researcher, academic institute, government or non-government organisation and government department, responsible for the
provision of such services. This includes, for example, family carers, support workers, volunteers, teachers, behaviour analysts,
psychologists, intellectual disability nurses, speech and language therapists, occupational therapists, psychiatrists, and key decision
and policy makers.
How can the framework be used?
The framework lists the competencies that define best practice. It is a resource that provides a common and shared knowledge and
associated actions necessary for the delivery of PBS. It could be used to help:
 develop a whole organisation approach to PBS
 develop a structured and progressive continuing education curriculum for all professionals involved in the delivery of PBS
 develop a structured and progressive training curriculum for PBS specialist practitioners
 provide a framework for human resource management including recruitment, retention and staff progression
 develop assessment tools with which to evaluate individual and group performances
 provide a way for consumers and commissioners to evaluate the likely quality of PBS providers
 provide a way for those seeking training and professional development to evaluate training programmes
 provide a baseline for research purposes
Any organisation or individual may develop curricula, tools, guidelines based on the framework that meet their own needs. The aim
is not to prescribe what these may look like; rather it is to provide a common basis upon which such resources may be developed.
What does the PBS Competence Framework look like?
The Framework is shown in table 2:
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Table 2: The PBS Competence Framework
1. Creating high quality care and support 2. Functional, contextual and skills based 3. Developing and implementing a Behaviour Support Plan
environments assessment (BSP)
Evaluating intervention effects and on-going monitoring
1.1 Ensuring that services are values led 2.1 Working in partnership with stakeholders 3.1 Understanding the rationale of a BSP and its uses
1.2 Knowing the person 2.2 Assessing match between the person and 3.2 Synthesizing data to create an overview of a person’s skills and
their environment and mediator analysis needs
1.3 Matching support with each person’s capabilities 2.3 Knowing the health of the person 3.3 Constructing a model that explains the functions of a person’s
and with goals and outcomes that are personally challenging behaviour and how those are maintained
important to them
1.4 Establishing clear roles and effective team work 2.4 Understanding the principles of behaviour 3.4 Devising and implementing multi-element evidence based support
(4 term contingency); understanding the strategies based on the overview and model Antecedent
function of behaviour strategies
 Antecedent strategies
1.5 Supporting communication 2.5 Supporting data driven decision making  Developing functionally equivalent alternative behaviour (to
CB)
1.6 Supporting choice 2.6 Assessing the function of a person’s  Increasing skills and communication
behaviour  Systems change and contextual interventions
1.7 Supporting physical and mental health 2.7 Assessing a person’s skills and 3.5 Devising and implementing a least restrictive crisis management
understanding their abilities strategy
1.8 Supporting relationships with family, friends and 2.8 Assessing a person’s preferences and  Arousal curve
wider community understanding what motivates them  Reactive strategies
1.9 Supporting safe, consistent and predictable 3.6 Developing the plan; outlining responsibilities and timeframes
environments
1.10 Supporting high levels of participation in 3.7 Monitoring the delivery of the BSP (procedural/treatment
meaningful activity fidelity/integrity)
1.11 Knowing and understanding relevant legislation 3.8 Evaluating the effectiveness of the BSP
1.12 A commitment to Behaviour Skills Training 3.9 The BSP as a live document
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The Framework is divided into three main areas, each of which details specific competencies that need to be achieved to deliver
effective support. These areas are:
Creating high quality care and support environments aims to ensure that organisations, and those providing individual
support, operate from a person-centred foundation. The purpose of person-centred support is to enable a high quality of life
for all concerned, which includes mitigating risk factors for the development and maintenance of behaviour that challenges.
The likelihood and impact of behaviour that challenges is likely to be reduced in supportive environments that meet a
person’s social, physical and mental health needs, and that facilitate engagement, communication, choice and control. Many
of the competencies described here, while having particular resonance in relation to supporting people with behavioural
challenges, should be staple features of any high-quality service for people with intellectual disability.
Functional, contextual and skills based assessment focuses more on emerging or established behavioural challenges and aims
to ensure that the support outlined for each person is based on a thorough understanding of that person’s needs,
preferences, abilities, communication style, the function for them of any behaviour that challenges and how this is
maintained, and the context and resources in which and with which such support may be given.
Developing and implementing a Behaviour Support Plan (BSP) also focuses emerging or established challenging behaviours
and aims to provide a detailed and personalised description of how best to support each person with developmental
disabilities and their behaviours of concern. It will include prompts to guide the behaviour of those supporting them,
strategies to redesign their environment and therefore reduce challenging behaviour, and a plan to develop their skills and
appropriate behaviour. The competencies relating to evaluating intervention effects and on-going monitoring aim to ensure
that a BSP continues to meet a person’s needs and is systematically adjusted in response to any changes in those needs, the
person’s skills and his or her environment.
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All of the competencies listed are necessary from the point of view of the person being supported. Regardless of provider, the
nature of provision, and the number of stakeholders involved, their overall support package should therefore reflect these
competencies in their entirety. This does not mean that all the competencies will need to be demonstrated by every individual
involved in that provision. While there are certain core competencies (particularly those around creating supportive environments)
which will be applicable to everyone, there are also specialist competencies which will be the focus of practitioners such as
psychologists, psychiatrists, speech and language therapists, behaviour analysts and any other professional leading on PBS within a
service setting.
For this reason, the framework details three levels of competencies by function: Direct contact, Behaviour
Specialist/Supervisory/Managerial and Higher Level Behaviour Specialist/Organisational/Consultant.
 Direct contact competencies are for all those providing direct support to persons with developmental disabilities who
may have behaviour that challenges. This may be in a paid or unpaid, professional or volunteer capacity (including
family members). Whilst these competencies are clearly important for those working on a day to day basis, it is likely
that anyone involved in the delivery of PBS services, including those in supervisory and strategic positions, will have
had experience of providing direct support at some point in their careers and will continue to do so from time to time,
such as when providing specialist individual support. These competencies are therefore not repeated at the
Supervisory and Strategic levels but will, nonetheless, be a requirement for those individuals who continue to have or
even occasionally have direct contact with persons with challenging behaviour.
 The Behaviour Specialist/Supervisory/Managerial and Higher Level Behaviour Specialist/Organisational/Consultant

competencies reflect the fact that increasing levels of complexity within service delivery necessitate additional
competence both in terms of systems support and clinical excellence. Behaviour Specialist/Supervisory/Managerial
competencies are for anyone involved in supporting those who provide direct contact. This may be in a supervisory
(e.g., directly supervising front line staff), managerial (supporting and responsible for supervisor and front line staff) or
“clinical” (responsible for assessment, devising and overall implementation of the BSP) capacity.
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 Higher Level Behaviour Specialist/Organisational/Consultant competencies are the highest level and are for those
responsible for embedding PBS into and across services and building capacity; but also include expert clinical
competencies required for the most complex systems and cases.
This structure, and the way in which the competencies are presented, acknowledges the fact that PBS will often be delivered by
multi-disciplinary teams. The levels are not therefore, necessarily, role specific. They are hierarchical, but only in the sense of
expertise in PBS and they reflect the three broad functions that are involved in the implementation of PBS. For example, a clinical
consultant depending on their role within a service, may not need or have PBS competencies at the highest level within the
framework.
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PBS Practice competencies Systems Support
Direct Contact
Systems Complexity requires higher level
Case/risk complexity requires specialist

managerial/strategic competencies
competencies
Behaviour Specialist/Supervisory/Managerial
Higher Level Behaviour

Specialist/Organisational/Consultant
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Competence Area 1: Creating high quality care and support environments
Aim: To ensure organisations and those providing direct support operate from a person-centred foundation to ensure a high quality of life for individuals supported and that they
proactively address risk factors for the development and maintenance of behaviour that challenges. The likelihood and impact of behaviour that challenges is likely to be reduced in
environments that meet an individual’s social, physical and mental health needs, and that successfully facilitate engagement, communication and choice-making.
1.1 Ensuring that services are values led
Things you need to know Things you need to do Why is this important?
DC The value base underpinning modern high quality services, Show dignity, respect, warmth, empathy, and compassion in all The key focus of learning
including: interactions disability support is
enablement, which is
The principles and practices of normalisation and inclusion, Treat every individual as a person and provide support that is tailored different from other
especially in relation to creating opportunities for to meet need ‘hotel’ models of care
increased community presence, stronger networks of and support.
relationships, greater participation in ordinary activities, Arrange and support participation in community activities and events
making a greater number of choices, developing skills, and
enhancing personal dignity and respect Search out and support the development of relationships
The principles and practice of person centred planning and Arrange and support participation in activities of everyday life
action
Arrange and support meaningful choice
The importance and meaning of adopting the least
restrictive approach Arrange and support opportunities for learning and development
Help and support behaviour and daily interactions that make the
person look and feel good.
Minimise any restriction of activities or movement; and use positive

handling strategies when needed in emergency situations
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SUP/ The importance of establishing clear leadership in setting Help shape and change, when appropriate, the values of the
MGR the culture of the organisation organisation.
Support other staff to describe and deliver the values and core aims of
the organisation, orally, in writing and in actions.
Provide positive feedback on staff performance related to their

support of the person’s community presence, relationships, choice,
behavioural skills and image.
Recruit team members with appropriate values and attitudes
Review and discuss team members’ attitudes regularly and support

team members to demonstrate positive attitude to the person.
Respond when positive attitudes are not present
Role model dignity, respect, warmth, empathy, compassion in

interactions at all times, and monitor this in the team
Facilitate feedback from the person and their family and friends on
how values are expressed in actions, and use this to shape and change
the organisation
Actively manage staff and the environment to build a positive

environment
ORG/ Understand the policies and procedures that enshrine Develop a values led strategic vision and philosophy for the
CST legislation and best practice and reflect the service organisation
philosophy base
Create the necessary infrastructure to support a values-led culture
Understand the principles of change management and the and documents that clearly communicate principles, values,
process of establishing an organisation-wide culture guidelines
Commission or develop training that will ensure that the service can
provide the support required by the individuals that it supports
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Develops partnerships with commissioners to ensure that they are
able to be actively involved in the initial provision of service and its
ongoing development
1.2 Knowing the person
DC The importance of developing relationships and rapport2 Develop a rapport with the person (can be evidenced by observing Social contact is a basic
multiple positive interactions between the staff member and person human need. In
The person’s individual history and family/social context supported) situations where the
person receives
The person’s interpersonal style, likes / dislikes, general Identify and describe how the person expresses enjoyment and unconditional, positive
skills and abilities displeasure in activities social interactions, in a
way that suits their
The person’s communication skills Directly support the person to access things that are important to preferred
them (preferences) and balances this with the things that are required communication style,
for them to have a good quality of life they are often less likely
to display challenging
Support the person across a range of activities and contexts behaviour to obtain
social interaction.
Reflect on your relationship with the person However some
individuals may not
favour social contact.
SUP/ The person’s individual history, health needs, Proactively support other staff to develop and maintain positive Understanding individual
MGR communication preferences, preferred activities / items, relationship with the person, for instance, by suggesting/supporting differences is important.
likes / dislikes, skills and abilities joint activities relevant to person’s interests and interactional style,
communication skills and abilities. Staff who establish good
relationships with
Why this is important individuals can embed
2
The close and harmonious relationship that needs to be developed between PBS professionals, service users, families and staff and which underpins effective intervention.
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Organise person’s personal documentation and collect, arrange or any necessary less
change this information as required by different agencies and systems positive interactions (e.g.
physical care that may be
Support the team to reflect on relationship with client, both the uncomfortable or
positives and the negatives. Organise person’s support to include distressing). Most people
circle of support3 meetings, key worker4 meetings and activities with (with and without
keyworker developmental
disabilities) want to
Offer support and guidance if direct contact staff are finding rapport receive positive social
building difficult, e.g. organises staff training in interaction techniques interactions from those
around them. (Allen et
al., 2013)
ORG/ The evidence base behind the reasons why everyone who Ensures that anyone having direct contact with a person either knows
CST has direct contact with an individual needs to have a them or knows where and from whom to get pertinent information
detailed knowledge of that individual
Interacts positively and respectfully all persons within the service
1.3 Matching support with each person’s capabilities and with goals and outcomes that are personally important to them
DC Each person’s strengths, needs, preferences, hopes, Collect information about a person’s strengths, needs, preferences, Everyone’s strengths and
dreams and aspirations hopes, dreams and desires needs are different and
people’s aspirations and
How to describe personally important outcomes for Help schedule the implementation of personally important goals ambitions will vary.
individuals that are observable, measurable, and timely Competent
Help measure progress toward personally important goals environments match
How to measure and assess change support to need on a
3
A circle of support is a network of friends, family members and supportive workers who come together to help promote and support the goals of a person with learning disability.
4
A key worker is someone who plays a lead role in planning and co-ordinating the delivery of services to a person.
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moment to moment
How to check for balance and timeliness when scheduling Help check that implementation balances across areas of life, type of basis, and have in place
the implementation of individualised goal-based support outcome and preferences ways of identifying,
implementing,
How to identify and report progress, problems and barriers supporting and
measuring a range of
How to communicate effectively with persons with limited goals and outcomes that
verbal ability are personally important
to the individuals that
How to communicate with family members and other own them.
significant persons
SUP/ The importance of person-centred planning Liaise with circle of support

MGR
How to implement a person-centred approach Organise and lead on collecting information about a person’s
strengths, needs, preferences, hopes, dreams and desires
Schedule the implementation of and measure progress towards

personally important goals
Check that implementation balances across areas of life, type of

outcome and preferences
ORG/ Multiple systems for person-centred planning Implement personalised systems for goal-based person-centred
CST outcome planning, implementing plans, and monitoring their impact
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1.4 Establishing clear roles and effective team work
DC The central functions and responsibilities of one’s own role Demonstrate appropriate level of support to the person, rather than Staff are the key resource
and the roles of others to support the wellbeing of doing too much for them, or not engaging with them in any support service.
individuals (i.e., direct support workers are enablers not Having high quality staff,
just to drive the bus, do all the cleaning/cooking etc.) Demonstrate the difference between care and providing personalised low staff turnover and
and active support5 effective teamwork is
critical to successful
The importance of establishing enabling relationships in Act as a key worker for one person or more outcomes.
empowering people to learn and manage as much of their
lives possible Provide peer support to colleagues
To maintain high but realistic expectations. The Actively participate in teamwork; attend and participate in team
relationship between one’s own behaviour and the meetings and supervision
behaviour of others
Maintain proper work timetables; advise supervisor if work hours risk
The importance of maintaining a sustainable pattern of becoming unreasonable
work
Reflect on own actions and feelings, and how these impact on the
The need to maintain professional boundaries (e.g., actions and feelings of others
conflicts of interest, social media contacts)
Seek support from supervisor/manager/peers when needed
Declare any personal and/or professional relationships that will or

might impact on job role or organisation’s functioning
Attend to own physical, psychological and emotional wellbeing
5
Active support (AS) is a multi-component person focused intervention that aims to improve the quality of life of people with an intellectual disability by increasing the opportunities to
participate in all types of activities of daily life with the appropriate support from staff (from Totsika et al., 2010)
25
SUP/ The role of supervision in terms of supporting the skills, Provide regular and frequent individual supervision for all staff
MGR training and personal wellbeing needs of others within the (detailed in supervision contract)
team such that they can fulfil their roles adequately
Observe staff working practices and provide verbal and written
The importance of practice leadership6 feedback – practice supervision – and systematically check procedural
fidelity9 in delivering agreed support plans
The impact of one’s own role; the roles of team members
and other key stakeholders Demonstrate good supervision skills in training and developing skills
around: understanding behaviour; work relationship dynamics;
The need for consistent approach amongst team members maintaining personal boundaries; work-life balance
The relevance of positive monitoring7, including Periodic Monitor staff wellbeing and mentor staff in this area
Service Review (PSR)8
Conduct appraisals, monitor staff performance, and identify and meet
How to facilitate decision-making training needs of direct care staff
How to resolve conflict Monitor staff awareness of their own behaviour and provide
feedback, guidance and supervision as needed
Lead and model the implementation of PBS in practice (i.e. practice

leadership)
Clarify staff roles in practice, and promote team work
Organise regular Periodic Service Review (PSR) and ensure

assessments are valid and that the results are readily apparent to
staff.
Facilitate regular team meetings to review and update support plans,

gain staff feedback, and involve staff in decision making.
6
A model of leadership in which managers prioritise spending time in the care environment and routinely role play and model desired standards of practice to their staff.
7
A system for monitoring, giving feedback on and improving staff performance first described by Porterfield.
8
A continuous process of quality assurance that was devised by LaVigna and colleagues and which is particularly useful for supporting the accurate implementation of positive behavioural
support.
9
A measure of how accurately and reliably a behaviour support plan is implemented.
26
Set clear goals and vision with team involvement.
Provide frequent and regular feedback to individuals and the team as

whole on everyday performance and progress toward goals.
ORG/ The strategic importance of effective team leadership Establish a human resource infrastructure and policies that facilitate
CST effective team working and encourage staff involvement
The importance of robust human resource management in
the support of a positive environment Implement good human resource and personnel management and
supervision procedures
The importance of effective staff recruitment and on-going
staff retention in a market in which there is often high Establish an effective staff recruitment process
turnover
Monitor reasons for high staff turnover and empower the
The importance of supporting the supervisors management team to address this issue
1.5 Supporting communication
DC That communication is critical for supporting autonomy, Effectively communicate and support the use of core communication Challenging behaviour is
wellbeing and quality of life systems (e.g., nonverbal, verbal, gestural, pictorial/textual) in all less likely when the
interactions with others person understands and
That communication needs differ from person to person, is understood by those
moment to moment, and across settings and social Use appropriate communication with different people depending on around them. Most
contexts needs people (with and without
developmental
Individualised communication plans should be developed disabilities) want to
for the person being supported communicate with those
around them, especially
27
The need for modifying one’s own communication style for Actively support, develop and change communication systems for those they are close to.
the audience and the importance of clear professional each person (e.g., keep a PECS symbols 10up to date, adapt to learning (Allen et al., 2013)
communication and behaviour change)
Contribute to the development of a detailed description of how best

to communicate with the person
Demonstrate appropriate communication methods at team meetings,

and daily interactions with persons and colleagues
SUP/ That communication is critical for supporting autonomy, Implement service/setting wide systems to facilitate communication
MGR wellbeing and quality of life and the role of supervision in (e.g., words/signs/pictures used to label doors, visual menus in key
supporting this settings)
The key functions of communication as they relate to Ensure that all persons being supported have individual
behaviour that challenges (i.e., request for tangible items communication plans, and that these are regularly updated
and social contact, removing unwelcome demand)
Ensure that the team has access to appropriate training about
The importance of teaching and supporting alternative communication
behaviour11 matched to the communicative function12 of
challenging behaviour Ensure that the staff team creates opportunities, relationships and
environments that increase a person’s motivation to communicate
Ensure team members know the assessed communicative function of

challenging behaviour and how to support alternate behaviour in its
place
10
Developed by a Behaviour Analyst and Speech and Language Therapist PECS is a form of augmentative and alternative communication. It is typically used as an aid in communication for
children with autism and other special needs. Learners are taught to exchange single pictures for items or activities they really want. (http://www.pecs.org.uk)
11
A socially valued behaviour that the person develops as an alternate to their challenging behaviour, typically through a planned process of skill development.
12
Challenging behaviours are often seen as a person’s most effective way of communicating a particular need. A behaviour’s communication function is best described as the ‘message’ behind a
particular behaviour.
28
ORG/ Functional communication training and the relevance of Establish system wide structures that comply with the regulatory
CST this to challenging behaviour framework14
A comprehensive range of augmentative and alternative Support communication development of staff (i.e., computer literacy
communication13 methods training)
Support staff in the understanding of more complex systemic

communication needs
Support assessment and intervention components that address

alternate functional communication
1.6 Supporting Choice
DC The importance of providing options, and that people may Provide experiences that enable the person to be able to make an Challenging behaviour is
express preferences in different ways informed choice in respect of activities also less likely when the
person is doing things
The importance of respecting a person’s choice, even if it Present opportunities for the person to make meaningful choices that they have chosen to
may not be your own do or with people that
Teach choosing skills they have chosen to be
The importance of supporting and (in some cases) teaching with. Most people (with
genuine choice making, of creating opportunities for and without
choosing, and of providing experience and knowledge developmental
about options and consequences disabilities) value the
opportunity to decide
The span of opportunities for choosing, from small day-to- things for themselves
day details to large life-defining matters, such where to (Allen et al., 2013).
live and how to spend time
13
Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas, including facial
expressions or gestures, the use of symbols or pictures, or written words. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to
help those with difficulties communicating.
14
The legislative and policy frameworks within which support services are delivered.
29
SUP/ The relationship between challenging behaviour and the Ensure that the staff team develops a person’s opportunities and
MGR opportunity for choice ability to make informed choices and that these are acted upon.
How to support the team to present and help a person

make informed choices
ORG The model of causality of challenging behaviour and the Establish the necessary infrastructure that facilitates the making of
/CST relationship between opportunities for choice and informed choices and that these are acted upon
challenging behaviour
1.7 Supporting physical and mental health
DC The importance of knowing the health and physical needs Implement individual health care plans including competent Challenging behaviour is
of the individual being supported administration of medication less likely when the
individual is healthy and
The importance of monitoring physical and mental health Support individuals to maintain physical health and wellbeing not in pain or discomfort.
needs (cleaning teeth, checking testicles, health eating choices, weighing Most people (with and
self, and exercise) without learning
That people with learning disabilities and limited disabilities) attach the
communication are less able to communicate needs Support access to health care systems, e.g. visiting GP highest possible value to
directly and therefore have higher rates of ill health and ‘good health’ and want
mortality; hence support team need to be able extra Identify and interpret an individual’s physical and emotional state to receive personal
vigilant on person’s behalf from non-verbal behaviours (i.e. facial expression, body movements, support in dignified ways.
other behaviour) (Allen et al., 2013)
The signs of a health problem for the person
Correctly administer medication according to the agreed protocol
Medications specific to the person being supported, why
taken and possible side effects Record and report any medical administration correctly
Ask senior manager or clinician for support/advice when needed

30
The administration of medication and any other prescribed Articulate what they might feel and think in response to the strategies
treatment approaches that are being implemented
The management of any specific condition relevant to the

person. e.g. epilepsy, diabetes, physical activity
The risk of over-medicating
Basic first aid
Who to contact for additional guidance on how to support

a health need/condition
SUP/ The physical and mental health needs of each individual Ensure each person is registered with a GP and has an annual health
MGR and the appropriate health professional to contact for check15
advice and support
Ensure each person has a health action plan that is reviewed regularly
The possible relationships between unmet physical or and is up to date, that includes as a minimum the need for annual
mental health needs and behaviour that challenges health checks, that indicates how the person expresses pain and
discomfort, and that contains details of medication and other
The possible impact of adverse life events on physical and treatments
mental health (e.g., historic abuse, neglect or current
poverty and social isolation) Establish and maintain good working relationships with all support
services to ensure multi-disciplinary team work is effective
When to seek specialist input, how it is obtained, and what
the barriers to accessing services are Design health access and care protocols (e.g. desensitization to
needles)
Methods of monitoring physical and mental health needs
Authorise and sign off as required medication16 protocols
15
Annual health checks provide an important means for routinely checking the general health status of adults with learning disabilities. For more info, see
http://www.nhs.uk/Livewell/Childrenwithalearningdisability/Pages/AnnualHealthChecks.aspx
16
As required (or pro re nata) medication is medication that is given when required (as opposed to medication that is prescribed to be given at set intervals. It may be prescribed for people who
present with behavioural challenges in order to reduce levels of agitation during periods of distress.
31
Treatments and interventions to support good mental Ensure team members are competent to administer medication and
health that are evidence-based for the persons being any other prescribed treatments and supports when needed
supported
Monitor team administration of medication and other treatments and
How to present information to specialist health other strategies to promote wellbeing
professionals involved in the person’s care in a planned
way and in an emergency Maintain data system; prepares for meetings with specialists (e.g.,
psychiatrists)
Support access to any additional professional help and to rapidly

respond to acute health concerns
ORG/ What health and social care systems and resources are Establish and maintains good working relationships with all health and
CST available to support complex cases care services to ensure multi-disciplinary team work is effective
The complexities involved in co-morbidity Collect and analyse data on physical and mental health and wellbeing
Ways of collecting and analysing data on health and Provide clinical expertise in complex cases involving co-morbidity
wellbeing
Develop a clear strategy for ensuring that the amount of medication
Medication, including as required medication protocols used is never more than is therapeutically necessary; establishes
monitoring and data collection process; ensures that data collected is
Intervention strategies from behaviour analysis that enable fed back into prescribing and administering process
a person to access mainstream or specialist health
services* Promote mental and physical wellbeing activities for person’s
supported as well as staff
* Competencies that require specialist behavioural Facilitate joint working with other disciplines, e.g. psychiatry
knowledge and abilities are shown in italics colleagues.
Design and support the implementation of a programme to enable a

client to visit their GP or local hospital
32
1.8 Supporting relationships with family, friends and wider community
DC The potential benefit of having a circle of support Actively engages with professionals and family, friends. Challenging behaviour is
less likely when the
The key people in the person’s circle of support Actively supports friendships and relationships with others. person is with family
members or others with
The importance of engaging with, and supporting, each Communicates effectively with the person’s circle of support by whom they have positive
person’s relationship with family members and other supporting the person to maintain key relationships, facilitating relationships. For most
people in his or her social network contact, visits etc., keeping family members and friends informed, people (with and without
learning disabilities),
Use formal and informal ways of sharing information relationships with family
and friends are a central
Seek advice from circle of support regarding best interest decisions part of their life. (Allen et
al., 2013)
SUP/ The importance of maintaining and developing each Ensure that each person has a circle of support. One of the defining
MGR person’s relationships with family and his or her social features of PBS (Gore et
network Facilitate and support staff to involve the circle of support in each al., 2013) is the
person’s life and to involve them in decision making. recognition that the
people who are the most
Identify and develop opportunities to build social inclusion. important part of a
person’s day-to-day life
Ensure goals relating to relationships with family, friends and the are those who are most
wider community are prominent in person-centred planning and likely to be involved in
implementation their support, and are
also connected to how
ORG/ The importance of community involvement in the lives of Establish the networks necessary to ensure family and community develops and is
CST persons at risk of engaging in challenging behaviour and participation maintained (Hastings et
the strategic importance of engaging with the family and al., 2013)
wider community
33
1.9 Supporting safe, consistent and predictable environments
DC The importance of maintaining a safe, predictable and Use strategies to help the person predict, understand and control Challenging behaviour is
stable environment their environment (e.g., visual timetable or social stories) more likely when the
person is supported
That some aspects of the environment can be risk factors Identify and avoid if possible aspects of the environment that may be inconsistently or when in
for challenging behaviour for some people, e.g. sensory a risk factor for challenging behaviour transition between one
aspects such as noise, light, space activity or environment
Implement interventions designed to help people cope with and another. Most
That those being supported may experience difficulty in challenging environments people (with and without
predicting, understanding and controlling the environment learning disabilities)
Develop personal activity schedules with routinely occurring activities value consistent and
That unpredictability and lack of control can evoke as anchors and a menu of other activities for choice and responsive predictable support.
behaviour that challenges flexibility (Allen et al., 2013)
SUP/ How to structure, review and monitor environments to Implement service-wide strategies to support consistent Challenging behaviour is
MGR maintain consistency environments (e.g., service or class wide timetables, clear rota of less likely in the absence
staff) of environmental
‘pollutants’ (e.g.
Model the use of systems, (e.g. visual timetables) excessive noise). Most
people (with and without
Ensure that scheduled activities take place learning disabilities) want
to live and work in safe,
Observe and provide feedback to staff on interventions to extend attractive environments
consistency and control of the environment where they feel at home.
(Allen et al., 2013)
ORG/ Systems and procedures necessary to maintain safe, Design policies and procedures to establish safe, consistent and
CST consistent and predictable environments predictable environments
Monitor the safety, consistency and predictability of environments

that define the service
Influence and change the system of support if it does not produce a

safe, consistent and predictable environment
34
1.10 Supporting appropriate levels of participation in meaningful activity
DC The link between engagement, activity and wellbeing Identify activities a person likes and create opportunities for the Challenging behaviour is
person to make them a part of daily life less likely when the
What makes activity meaningful for a particular person person is meaningfully
The importance of developing a person’s skills so that they Help the person do something they like for most of the time occupied. Skilled support
are able to engage in activities as independently as ensures that they can
possible or as they wish Help the person do things they do not like, but that are essential participate at least
partially even in
The importance of help (support and assistance) to bridge Introduce new activities so that a person has more activities to choose relatively complex
the gap between what is needed to do an activity and from activities so that they
what a person can’t yet do independently learn to cope with
Support the person to develop skills in order to do things as demands and difficulties
The link between activity engagement and self-image, independently as possible that might otherwise
personal accomplishment, and perception of others provoke challenging
View complex activities as a series of simpler activities arranged in a behaviour. Most people
sequence of steps that a person is able to do with help. (with and without
learning disabilities) like
Adapt the level of help for each step so the person can join in as much to be busy. (Allen et al.,
as possible 2013)
Supply extra motivation and reward for low- or non-preferred The development of new
activities skills and independent
functioning enables the
Schedule the day so the person has at least one activity available at all individual to have more
times, (most often more than one), and the support required to control over their life.
perform the activity Most people (with and
without learning
Intersperse low-preference and high-demand activities with low- disabilities) like to be
demand high preference activities independent. (Allen et
al., 2013)
Keep track of what people do to make sure it is often enough, of good
quality, spread out in time, and has enough variety and interest
35
SUP/ What meaningful engagement means for each service user Ensure that staff supporting the person develop good links with the
MGR local community
How careful presentation of activities can avoid evoking
behaviour maintained by escape from aversive demands, Support staff to identify and develop meaningful activity for each
and can instead lead to engagement that will often create person throughout each day, using core activities as ‘anchors’
the feeling of control, and contact attention from others
and contact with tangibles Coach staff to break down complex activities into steps (carry out task
analysis) and vary the help they provide at each step
What each service user has as their next goal, e.g. to go on
holiday, to go for a trip out, to do a course, to work Coach staff to provide just the right amount of help
Local community organisations and what they offer Monitors that each service user has meaningful activity in their lives,
and things they are looking forward to goals they want to achieve
ORG/ A detailed understanding of available resources, including Secures the resources necessary to ensure that all persons supported
CST sources of funding that might be used to provide are able to engage in meaningful activities
meaningful activities within services
Provides a clear expectation that participating in everyday activity is a
Understands the model of causality of challenging key outcome
behaviour and the relationship between meaningful
engagement and challenging behaviour Supplies operational and procedural guidance for supporting activity
engagement – active support training and practice leadership
Measures participation and community involvement as outcomes and

reports to stakeholders along with data on the occurrence of
Designs interventions that enable persons to develop new skills and to

access and participate in meaningful activities
36
1.11 Knowing and understanding relevant legislation
Good practice seeks to
DC That the Mental Capacity Act; Deprivation of Liberties Identify and apply key points from relevant legislation implement fully the
Safeguards (DOLs); Mental Health Act, Human Rights Act principles enshrined in
and other legal issues relate to restrictive practices Participate in assessing mental capacity of the person in everyday care legislation and failure to
including physical intervention giving and interactions do may have legal
consequences for which
Health and Safety responsibilities in the workplace individuals and/or
including risk assessment and duty of care organisations are liable.
Safeguarding procedures in the work place
SUP/ When legislation (Mental Capacity Act; Deprivation of Ensure relevant legislation is understood by staff and is implemented
MGR Liberties Safeguards (DOLs); Mental Health Act, Human appropriately
Rights Act and other legal issues relating to restrictive
practices including physical intervention) comes into In the case of DOL standards, ensure that court of protection has
practice approved any restrictions agreed by multi-disciplinary team
Who should be involved in capacity assessments and best Monitor and review use of restrictive practices on a regular basis.
interests decisions based on the nature of the decision
Monitor Quality of life indicators
Contact appropriate people to involve them in capacity assessments

and/or best interests decisions and arrange assessments
ORG/ Current legislative framework. Ensure that all staff have access to updates to legislation as necessary.
CST
Where to find relevant case law and/or seek specialist Ensure that policies and procedures meet current legislation and are
advice. up to date.
Ensure that policies and procedures feed into service philosophy
37
Lead strategic process, safeguarding, training as required
Develop a culture in which it is safe to report
1.12 A commitment to Behaviour Skills Training
DC The importance of both initial and on-going training Participate in training programmes identified for all staff Developing and
maintaining a competent
Participate in specific training in the implementation of interventions workforce is key to
or support that have been identified within a Behaviour Support Plan successful outcomes in
any service sector. It is
particularly pertinent in
SUP/ A range of training and support strategies for stakeholders Implement systems and procedures to teach skills (e.g. session the care of those with
MGR and others in the system planning) on rota and person’s timetable behaviours that
challenge because of the
The behaviour skills training approach for teaching staff: Support others to complete training/support programmes and ensure relationship between
instructions, modelling, rehearsal, feedback and in-situ resources are available challenging behaviour
training and the social
Ensure staff receive proper training in a timely manner, especially if environment.
restrictive interventions are being used
Use the behaviour skills training approach when teaching staff
Develop rotas and shift plans which include time allocated for
behaviour skills training
ORG/ A comprehensive and up to date knowledge of Discuss with staff their understanding of the person’s communication
CST communication and skills teaching needs
Conduct training audits, identify gaps in staff knowledge and deliver

training support as required
38
Competence Area 2: Functional, contextual and skills based assessment
Aim: To ensure that the support outlined for each person is based on a thorough understanding of that person’s needs, preferences, abilities, communication style,
the function for them of any behaviour that challenges and how this is maintained, and the context and resources in which and with which such support may be
given.
2.1 Working in partnership with stakeholders
DC That a full assessment of a person and their situation necessities Contribute necessary information to the assessment process It is vital that any
the involvement of all of the key people who play a part in their assessment and
lives: the person him or herself, their carers, family members, Support the person so that they are able to contribute to their intervention is compliant
support workers (paid and voluntary), and professionals. own assessment with the Mental Capacity
Act (2005).
The importance of the assessment of capacity and the implication Support the person through any assessment procedures that
for consent may require their participation Stakeholder input is
essential to determine
Own role in the assessment process Identify and describe who key stakeholders are, how and why priorities and targets for
they are involved in the assessment and implementation of support, to ensure the
the BSP form of selected
interventions and
Communicate effectively and politely, listen to views of others assessments are suited
and ask relevant questions when working with stakeholders and achievable within
the focal person’s life
context, and to validate
the social significance of
outcomes pursued
(Dunlap et al., 2008)
39
Stakeholder involvement
SUP/ The importance of co-production and recognition of the expertise Explain in detail the importance of stakeholder involvement involves critical people
MGR of everyone involved (i.e., family friends) in
Contribute to team information and identify who else may be understanding a person’s
able to contribute to information. needs and formulating
plans to meet them. This
Ensures that either person’s consent or best interest approval is Ensure that the right stakeholders are involved in each aspect is a core definition
given for assessment. This should include consent from family or of the assessment process and support that involvement feature of PBS (see Gore
staff members also if they are to be subject to assessment. when necessary et al., 2013)
Who the key stakeholders are for each person supported
ORG/ The critical importance of stakeholder involvement Enable/establish necessary infrastructure/policies to establish
CST links and sustain stakeholder involvement
The challenges of facilitating stakeholder involvement and know
how to overcome them Outline strategies for stakeholder engagement
2.2 Assessing match between the person and their environment and mediator analysis
DC The importance of the practicalities of support delivery and why Provide constructive input to PBS plan development in terms It is essential that any
these need to be considered in support plans of the practical aspects of delivery positive behaviour
support plan or
The importance of consistency in the implementation of BSPs and Identify barriers to implementation in both the assessment intervention is able to be
the need therefore to identify barriers to implementation process and as they arise and raise concerns with the team delivered in the setting in
which it is designed for:
Own personal resources and how to seek support and training Seek support appropriately and provide appropriate support that the resources are in
related to implementation of the plan to others within the team place to facilitate that
delivery, staff have the
Local services, systems, professionals and procedures available to Identify and describe resources available; find information training necessary,
support implementation of the plan and seek guidance about resources as required change enhancers are
optimised and barriers to
40
implementation are
SUP/ An understanding of change enhancers and barriers, what will Assess environment, support skills, person, and identify addressed.
MGR support implementation and what will get in the way, including strengths (change enhancers) and limitations (change
team competence barriers) to implementing plans and feed this into the Being able to deliver a
planning process plan is key to reducing
The monetary and physical resources e.g. transport available to placement breakdown
support implementation of plan Ensure goodness of fit survey17 of the PBS plan is conducted and preventing out of
area placements.
Ensure that audit of team competence is conducted
Coordinate and ensure immediate resources are available to

support implementation of the plan.
Raise resource issues and needs on an organisational level
ORG/ The wider systemic factors that influence behaviour, including the Assess the resources at macro organisational level
CST societal, cultural and policy context
Develop strategic plans which secure the resources necessary
The resources/infrastructure necessary to support a PBS to support a PBS framework
framework in terms of model of care and assessment pathways
Develop strategic plan for whole team training and continued
The importance of contextual fit18 and how the needs of the professional development
population might be assessed and resources made available
17
A means of checking whether carers charged with implementing behavioural support plans have the necessary skills and resources to do so.
18
Contextual fit is the extent to which the elements of a behavior support plan are consistent with the values, skills, resources, infrastructure and support available to those responsible for
implementing the plan.
41
2.3 Knowing the health of the person
DC The link between mental and physical health problems and Support the person through any medical assessment needed Challenging behaviours
challenging behaviour may be related to an
Monitor health of person and report any changes that may underlying sensory
The physical and mental health needs of the person necessitate assessment problem or a physical
health problem,
Recognise and report any signs of distress in the person that especially those resulting
may indicate a health problem in pain. (Hastings et al.,
2013)
SUP/ That health needs are a priority within assessment Arrange full health assessments as part of any initial
MGR assessment and routine medical health check-ups as a follow
That the quality of life and physical and mental health are up
interrelated
Arrange medical assessment following any significant change
Specific syndromes and conditions that may indicate behavioural in behaviour
profiles
Liaise with medical team to facilitate the physical and mental
The limitations of own knowledge, and the need for other health assessment of the person (e.g. preparation for invasive
professional input investigations)
Support specialists in conducting assessments from the

management of challenging behaviour
ORG/ The importance of physical and mental health and supports others Prior to other assessments ensure an appropriate professional
CST in the organisation in that understanding conducts a full health assessment
The infrastructure available to be able to assess health/access to Include in reports that syndromes and conditions have been
medical assessment considered
Who to go to for information on rare genetic syndromes and /or Assessment demonstrates the relationship between health
complex health issues/mental health issues and quality of life
42
Communicate assessed relations to stakeholders the
interrelatedness of quality of life and physical and mental
health and ensure these factors are included in assessments
Ensure organisation has access to primary health care; care

pathways, establish links with local hospitals and specialist
services,
Make referrals, liaises/coordinates at senior level with

specialists in specific syndromes/complex health issues
2.4 Understanding the principles of behaviour (4 term contingency), how behaviour is learned and understanding the function of behaviour
DC That behaviour happens for a reason and that our collective role is Identify and clearly describe behaviour and environmental Challenging behaviour is
to understand what that purpose is antecedents in observable and measurable terms best understood as
(distinguishes between judgements and descriptions) learned behaviour that
That all behaviour (apart from reflex) is learned and that an relates directly to
understanding of how behaviour is learned can be used to teach Identify and report other variables that might affect the antecedent events and
new skills person (e.g. illness, relocation, medication) reinforcing consequences
(Gore et al., 2013)
The 4-term contingency19: motivation, antecedents, behaviour, Recognise the effect of own behaviour on the person and
and consequences (definitions, dimensions, relationships adapts accordingly A sound knowledge of
between) the principles of
behaviour is one of the
The 4 common functions of challenging behaviour: Social key elements to inform
attention; Avoidance/escape; Access to tangibles; Sensory an effective BSP.
stimulation
The difference between the form (what a behaviour looks like) and
its function
19
The four-term contingency is the interdependent relationship between any establishing or motivating operations (MO), a discriminative stimulus, behaviour and consequence.
43
The effect of the interaction of own behaviour and that of the
person
SUP/ In depth understanding of principles, processes and concepts of Support the team in developing an understanding of why
MGR Behaviour behaviour occurs for every person supported recognising that
those reasons will be specific to that person
The dimensions of behaviour:
- Frequency Support the team in understanding the effect of their own
- Intensity behaviour on others including the person supported and help
- Latency them adapt accordingly
- Duration
Achieve relevant qualification to demonstrate high level of
knowledge
Participate in regular clinical supervision
ORG/ In-depth understanding of Principles, Processes and Concepts of Achieves relevant qualification to demonstrate high level of
CST Behaviour knowledge
The contingencies within the organisational system, and teams Participates in regular clinical supervision by experienced
and how these can translate into effective intervention of barriers peers
to implementation.
44
2.5 Supporting data driven decision making
DC The importance of data-driven decision making Record data according to the agreed procedures A data driven approach
avoids clinical decision-
Data collection methods: (includes any data relevant to the FBA, making on the basis of
e.g. behaviour recordings, preference assessment20, quality of life personal opinion or
measures, use of restrictive practices, individual and carer injury circumstance and
recording)) provides the most ethical
and effective means of
The importance of baseline data operating (Gore et al.,
2013)
The importance of on-going data collection and the need for:
consistency; timeliness; unobtrusiveness; procedural integrity
SUP/ The strengths and weaknesses of various data collection methods Put in place data collection procedure appropriate for the
MGR and the appropriate method for the behaviour(s) in question behaviour, the dimensions of that behaviour (frequency,
intensity, duration etc.) and the context in which it occurs
The application of data collection procedures to evaluate goals in
the BSP; and the need for functional graphical and tabula Trains and supports staff in data collection procedures
representation of data
Analyse and produce graphical and tabular representation of
data
ORG/ Data collection procedures (e.g., frequency, duration, partial & Establish an infrastructure that supports data driven decision
CST whole interval, momentary time sampling) making
Design and implement the most effective data collection

procedures (e.g., frequency, duration, partial & whole interval,
momentary time sampling)
Design assessment procedures to evaluate effectiveness of

interventions, to inform evidence
20
A procedure for establishing a person’s likes and dislikes. Also referred to as Motivational Assessment.
45
2.6 Assessing the function of a person’s behaviour
DC What is meant by the term functional assessment and what a Contribute to the assessment process as required A PBS plan is based on
functional assessment aims to do the principles of
Support the person through the assessment process as behaviour analysis, in
What is meant by the term functional analysis and what a appropriate identifying the functions
functional analysis aims to do of the behaviour to
Support other key stakeholders through the assessment develop a multi-element
process as appropriate plan
Evidence suggests that

SUP/ A range of functional assessment tools and their strengths and Use multiple-data gathering tools to compensate for including a functional
MGR limitations weaknesses in individual measures analysis as a part of
intervention for
The triangulation21 of data from a number of sources Use a range of functional assessment tools and support challenging behaviour
stakeholders participation where appropriate: Semi structured also improves outcomes
interviews; Rating Scales; Reviewing recordings; Direct (e.g. Scotti et al., 1991;
observation strategies; Triangulation of data Carr et al., 1999; Didden
et al., 1997 Campbell,
Take an active role in supporting ORG/CST specialists in the 2003; Harvey et al., 2009)
conduct of hypothesis testing through experimental functional
analysis
ORG/ The importance of having specialist behaviour analytic services to Complete functional assessment incorporating all variables of
CST assess the function of behaviour the person, environment, staff team and organization
How to select the most effective assessment procedures and the Conduct and support experimental functional analysis where
ethics of completing functional assessment this is indicated to derive functional hypotheses
Situations when hypothesis testing is indicated Demonstrate triangulation and synthesising of assessment
outcomes to develop a clear hypothesis
21
The process of bringing together data from different types of behavioural assessment in order to enhance the accuracy of our understanding of why a behaviour is occurring.
46
The safe design and conducting of hypothesis testing through Produce and communicate assessment results in an accessible
experimental functional analysis form that enables supervisory and direct support staff to
integrate findings into support plans
2.7 Assessing a person’s skills and understanding their abilities
DC An understanding of the impact of intellectual disability (e.g., that Participate in a skills assessment as required PBS focuses on the
learning is different, can take a long time and needs specific building of skill
supports) Support the person in a skills assessment as required repertoires; challenging
behaviour can be viewed
An understanding that developing a person’s strengths is the most Objectively record levels of independence in tasks as a form of
effective way to build skills repertoires communication and
building skills can enable
A range of tools that may be used to assess a person’s skills people to communicate
their needs in a more
functional way. Skills
SUP/ The relevant assessment tools to determine skill and ability levels Select and conduct appropriate skills assessments building also enables a
MGR person to lead a more
The importance of including communication skills as part of this Detail a communication profile in assessment reports independent life (Gore
assessment et al., 2013)
ORG/ The outputs of the BSP should emphasise a person’s strengths and Use and interpret appropriate assessment tools to determine
CST building skills current skill levels and appropriate next steps in skill building
The need to select the most appropriate skills required to

encourage independence
47
2.8 Assessing a person’s preferences and understanding what motivates them
DC Why it is important to assess a person’s preferences Identify what is important for the person’s, likes and dislikes Understanding that
and contributes this information to the BSP everyone has the same
How the person expresses enjoyment in activities basic human needs and
Distinguish between what is important to and important for that identifying these is
the person an important part of a
BSP
SUP/ The relevant assessment tools for assessing preference and Use and interpret appropriate assessment tools to determine
MGR motivation current preferences. Understanding what
motivates people is an
The need to lead and communicate to staff teams the need to Demonstrate use of on-going preference and motivational essential element of
identify potential reinforcers assessments understanding them as a
person
The need to lead and communicate that motivation may change
ORG/ That the outputs of the BSP should make use of the information Use and interpret appropriate assessment tools to determine a
CST arising from a preference assessment; both for addressing person’s preferences and incorporate this into the BSP
challenging behaviour ad skills development
48
Competence Area 3: Developing and implementing a Behaviour Support Plan; Evaluating
intervention effects and on-going monitoring
Aim: To provide a detailed and personalised description of how best to support each person with developmental disabilities and behaviour that challenges;
including prompts to guide the behaviour of those supporting them, strategies to redesign their environment and therefore reduce challenging behaviour,
and a plan to develop their skills and appropriate behaviour; to deliver support in a way that and is consistent with the Behavioural Support Plan (BSP)
3.1 Understanding the rationale of a BSP and its uses
DC The purpose of a BSP is to improve the quality of life for a person Understand and be able to implement a BSP accurately There is evidence to
and reduce challenging behaviour and the use of restrictive suggest that good quality
practices Follow three steps of BSPs may lead to better
 read and absorb each BSP for every person being outcomes (Cook et al.,
A BSP is a written plan which: supported be able to demonstrate that the 2010)
 describes a personalised intervention and the data strategies described are understood and followed
informing that intervention. correctly
 should act as a practical tool to guide to be followed  seek clarification for any aspect that is not
consistently by all carers. understood
 will act a safeguard to protect the rights of both, persons
with developmental disabilities and those who support Take part in supervision and receive feedback on accuracy of
them implementation.
SUP/ All of the elements that constitute a good BPS: Ensure that all members of the support team understand
MGR and are able to accurately implement each BSP, for every
 the contextual nature of challenging behaviour and how it person being supported
serves a function for the individual
Demonstrate to members of the team the strategies
described within the BSP
49
 support strategies that are evidence based, multi-element
and use preventative antecedent interventions but also seek Direct anyone new to the team to the BSP and offer
to offer the individual a functional alternative behaviour supervision to ensure they can demonstrate required
when appropriate. There should be clearly defined standards.
reinforcement strategies
 a robust crisis management strategy based on least Maintain quality by offering direct coaching to others in
restrictive options implementation of strategies and provide regular
 a plan to ensure effective team coordination and performance feedback
communication
ORG/ That in the UK, BSPs are recommended for all people whose Establish service quality standards that every person, being
CST behaviour challenges and that the quality of a BSP may have an supported, will have an active, meaningful BSP implemented
impact on outcomes with integrity
The need for specialist behaviour support in the development of Ensure that BSPs are audited regularly and that an action
BSPs plan to address deficits is developed and implemented
Coordinate access to further specialist behavioural training

and consultation when required
3.2 Synthesizing data to create an overview of a person’s skills and needs
DC How the information and data that contributes to a person’s BSP, Contribute to the assessment process as part of a multi- A BSP needs to be
comes from a variety of sources: the person themselves - where disciplinary team: those who provide direct support often individualised, based on
possible; those who know them well; personal records; preference know the person best accurate information,
assessments, skills based assessments and functional assessment of from a sufficiently wide
a person’s behaviour range of sources and be
socially valid.
50
SUP/ The information that each of the data sources/assessments provide Take responsibility for data management by collating and Having team members
MGR presenting data in a form that facilitates analysis with specialist
The relationship between data gathered and the science of behavioural training has
behaviour Interpret data within context of agreed monitoring strategy been found to be
associated with higher
The application of this understanding to meet a person’s needs Seek clarification from behavioural specialist when data is quality BSPs (Cook et al.,
confusing or unexpected 2007; Webber et al.,
2011b; Van Acker et al.,
2005)
ORG/ Behavioural specialists overseeing BSP will have a detailed Establish the necessary infrastructure to facilitate the
CST understanding of the science of behaviour within the overall context synthesis of data
of the PBS model; the processes involved in synthesising data from
multiple sources; and the application of that information in order to Synthesise data from relevant skills and functional
create an overview of a person’s skills and needs. Will be able to assessments to create an overview of a person’s skills and
integrate other evidence based interventions by co-ordinating work of needs
other clinical specialists
Work collaboratively with stake holders in the reporting
Those responsible for organisation resources will have results of assessment
knowledge of the infrastructure and available resources that
contribute to the development of an effective BSP
3.3 Constructing a model that explains the functions of a person’s challenging behaviour and how those are maintained
DC That a Functional Behavioural Assessment (FBA) helps to understand Identify the environmental variables associated with All behaviour serves a
what the challenging behaviour(s) look like, the contexts in which challenging behaviour for the person purpose and is therefore
they might occur and the purpose they serve for the person of value for the person
concerned concerned. A BSP must
identify and describe the
That behaviour is influenced by context i.e. What happens in the function of the
environment may increase the likelihood of the behaviour occurring challenging behaviour
both to develop a plan
51
that teaches functionally
SUP/ The conceptual framework of challenging behaviour Help team members understand that their own behaviour equivalent replacement
MGR may contribute to challenging behaviour occurring. behaviour and to avoid
About contingency diagrams and how they are constructed the inadvertent
reinforcement of
challenging behaviour.
ORG/ Organisational managers will know how to access expertise from Construct a formulation that explains the functions of a In the absence of FBA
CST behavioural specialists who will have a detailed knowledge of the person’s challenging behaviour and how it is maintained. information,
conceptual model of challenging behaviour; the factors that maintain practitioners are at risk
it and the relationships between those factors Describe and explain each formulation to the teams involved of developing plans that
in supporting each person with challenging behaviour. are either based on
previous cases,
Offer staff training, at all levels, to help them understand the topography, or
formulation. practitioner preference
and are likely to be
Describe how the important variables surrounding an ineffective (Steege and
individual and their care team, interact to produce Watson, 2009)
challenging behaviour within a contingency diagrams
3.4 Devising and implementing multi-element evidence based support strategies based on the overview and model
DC A good BSP should: Contribute to the identification of antecedent strategies Behaviour is influenced
 Prevent the conditions that lead to challenging behaviour included in a BSP. Be able to demonstrate that they are by the presence or
occurring. These conditions will be identified during the understood and followed correctly and raise concerns if it is absence of specific
FBA. not possible to put them in practice. environmental variables
 Include teaching strategies that offer the individual an that increase the
appropriate, alternative behaviour to serve the same Ensure understanding of the teaching strategies and likelihood of the
function as the challenging behaviour, making it redundant protocols within the BSP and question anything that is not behaviour occurring.
 Show how new behaviour will be reinforced when being be fully understood
developed, maintained, and generalised across settings Having alternative skills
that achieve the same
52
results as challenging
Basic behaviour principles and the behaviour techniques employed Teach and support a new skill / communication and/or behaviour means that
in teaching skills and communications: reinforcement, prompting, increase a development of a skill/communication method the challenging
shaping, modelling, task analysis already in the person’s repertoire based on PBS behaviour is no longer
implementation plan (to include appropriate use of needed.
The role of antecedent strategies discriminative stimuli, prompting and reinforcement
methods). This includes skills and communications that are New behaviour must be
How behaviour is learnt and how to create and spot learning functionally related to the challenging behaviour and those reinforced if it is to be
opportunities that are to be supported in a broader sense developed, maintained,
and generalised across
The importance of developing functionally equivalent alternative Increases engagement levels for an individual via strategies settings.
behaviour22 (to CB) outline in implementation plan
The role of enhancing engagement23 Demonstrate implementation of antecedent strategies

related to the person’s plan that may include: Making
The value of supporting change in wider system through skills changes to the physical environment, increasing choice and
development and support control, providing non-contingent reinforcement24,
increasing individual support during demanding activities,
That for system wide interventions to be effective, people have to supporting mental health and or physical health needs that
work together serve as setting events for behaviour that challenges
System change is inevitable and brings both opportunities and Offer choice and promote independence
challenges
Increase engagement levels for an individual via strategies
outline in implementation plan
Actively support and respond to change in the system about

the person they are working with
22
A behaviour which serves the same function or purpose (i.e. achieves the same outcome) as the challenging behaviour.
23
Short-hand for ‘engagement in social or constructive activity’, a frequently used research measure that captures one aspect of a person’s quality of life.
24
NCR can be used as an antecedent strategy by providing the maintaining reinforcer non-contingently (i.e., so that the learner does not have to engage in the problem behaviour to access
reinforcement).
53
SUP/ The theory behind the application of antecedent strategies; a range Review potential antecedent strategies during BSP
MGR of antecedent-based support strategies and how these are development and raise concerns if impractical
implemented
Teaching strategies (skills teaching and functional communication Ensure that antecedent strategies are shared and
skills teaching) and procedures’ including task analysis, chaining, understood by the team and that necessary resources are in
shaping, modelling, prompting, discrete trial teaching25, natural place
environment teaching26, establishing stimulus control27
Contribute to the development of teaching strategies and
The principles of reinforcement, maintenance and generalisation. protocols
Appreciation of how other evidence based interventions may be Check each member of the team understands the teaching
used as an element of the PBS plan where indicted (e.g., Cognitive strategies and protocols within the BSP, through supervision
Behaviour Therapy) and observation of practice
Appreciation of and ability to apply principles of organisational Ensure that resources are available for teaching
change management opportunities
Identify wide range of options to be used to reinforce

appropriate behaviour for each person
Model antecedent strategies to staff and support them in

their implementation
Support staff in the promotion of choice and independence.
Support staff to increase engagement levels for the person

via strategies outline in implementation plan
25
A structured instructional teaching method based on the four-term contingency (see below) in which the person teaching sequentially presents an instruction and provides a consequence for
the response for a number of trials.
26
(Also sometimes called Incidental Teaching) is an instructional method similar to that of Discrete Trial Teaching and also based on the four-term term contingency. The difference is that in
NET the teaching opportunity is learner rather than instructor initiated; i.e. the learning opportunity arises as a result of the learner’s motivation to do or to want something at that point. It is
often initiated by requests for preferred items which are likely to serve as reinforcing consequences for any correct responses. It is also less structured and takes place in the context of other
activities.
27
Stimulus control is a situation in which some dimension of behaviour is altered by the presence or absence of a specific antecedent stimulus (e.g., Stimulus = green man shows at a pelican
crossing; response = cross road) Establishing stimulus control is an important aspect of behaviour change, is widely used in teaching, and plays a critical role in most forms of learning.
54
Relate skills teaching and increasing the communication
repertoire to the support plan and short, medium and long
term aims/goals, ultimately leading to improvements in
quality of life that are measurable and appropriate
Empathise with and support other staff to empathise with

person’s communication needs
Explain in detail how person lives in complex interacting

systems
Advocate for person and staff team when resources are

needed
Ensure the physical environment is an appropriate match for

the person and recommend changes in line with their needs
ORG/ A comprehensive and up-to-date knowledge of implementation Ensure service has access to required expertise to advise on
CST procedures in respect of behaviour analysis best practice.
How antecedent interventions can reduce the likelihood of Ensure general organisational systems support individual
challenging behaviour occurring. antecedent intervention (e.g. consistent workforce,
maintaining routines, minimal disruption).
How teaching strategies can offer a replacement and appropriate
behaviour to serve the same function as the challenging behaviour Ensure that antecedent strategies are understood by
and therefore rendering it redundant. everyone within the system and necessary resources are in
place to maintain fidelity
How teaching strategies can foster skills development
Ensure the highest levels of consistency are maintained for
Current developments and training opportunities of national most complex individuals
standing to maintain and enhance quality services.
Maintain standards for all teaching protocols
That interventions are often system wide and need active
management/support Ensure on-going, continuing professional development
activities around clinical practice
55
How system change can be difficult for staff and the need to support Speak with wider staff team to understand the system needs
them
Design and support staff in the implementation of system
wide interventions
Support staff reflection
3.5 Devising and implementing a least restrictive crisis management strategy
DC When challenging behaviour does occur, it needs to be managed Check own understanding of the crisis management To protect the individual
safely and effectively with the least restrictive options strategies and protocols included in the BSP and question and carers, ensuring risk
anything that is not fully understood of harm is minimised.
Known critical periods/ events for each individual that may increase
the chance of challenging behaviour occurring Identify early warning signs that challenging behaviour may To follow national best
occur. practice as per Positive
The written crisis response within the BSP for each individual and Proactive Care
Remain calm and implement crisis plan quickly, ensuring (Department of Health,
Each crisis management strategy is unique to an individual safety of everyone. 2014), Physical
Interventions: A Policy
The legal and ethical expectations when responding to someone in Framework (Harris et al.,
crisis Identify where on cycle of arousal person is at and respond 2008), BILD Code of
accordingly Practice for minimising
General signs of anxiety as well as person-specific indicators the use of restrictive
(precursors) Change strategies (e.g. lowers demands, clarifies routine)s at physical interventions
different stages of cycle (Fourth Edition) (BILD,
The cycle of arousal28 both for the individual and themselves 2014)
28
A term used to describe the changing pattern of changing arousal that is typically seen during an incident of challenging, particularly aggressive, challenging behaviour. Also known as the
assault cycle or time-intensity model.
56
Different strategies appropriate at different points in the cycle Record and report accurately (e.g. strategies used, details of To endure that the
the incident, injuries sustained). delivery of restrictive
Own signs of stress and anxiety; understands own strengths and practices is subject to an
areas for development Follow BSP - doing proactive first, least restrictive, safety, organisational plan to
escape route, paperwork completed appropriately – show limit their use as per
A range of de-escalation29 techniques and ethical reactive what already tried Reducing the use of
strategies30 restrictive practices with
Use knowledge from training when unplanned strategies are people who have
The recording and reporting process needed; make sensible judgements in unforeseen intellectual disabilities. A
circumstances practical approach (Allen,
What constitutes aversive and restrictive interventions31 and 2011)
restrictive practices Seek help for self when necessary
Own role within the crisis management protocols Implement ethical reactive strategies in practice
Reflect on experience of delivering reactive strategies
SUP/ Ethical and legal framework around responding to someone in crisis Check the team’s understanding of the crisis management
MGR strategies included in the BSP and address anything that is
Competence required of staff team to deliver crisis response not fully understood
Failures in system that lead to crisis Ensure that all staff have been trained appropriately by a
suitably qualified trainer with opportunity to practice
What is meant by “least restrictive” and a range of strategies that procedures through modelling, practice and feedback
can be used to achieve this
Ensure that staff rotas and resources enable crisis
management procedures can be followed if needs be
29
A general term to describe strategies that may be used to help calm a person who is showing early signs of behavioural escalation. Also known as secondary prevention strategies.
30
Safe, ethical responses for responding to behavioural challenges that are not preventable. They might include non-physical and physical interventions and the use of as required medication.
31
Restrictive interventions are: ‘any deliberate act on the part of other persons that restrict an individual’s movement, liberty and or freedom to act independently in order to:
• take immediate control of a dangerous situation where there is a real possibility of harm to the person or others if no action is undertaken and;
• end or reduce significantly the danger to the person or others; and
• contain or limit the person’s behaviour for longer than is necessary’ (Positive and Proactive Care, DOH, 2014)
57
The cycle of arousal: knowledge of general signs of anxiety as well Recognise the early warning signs that a person is becoming
as person-specific indicators (precursors); knowledge of different agitated (moving off baseline level of arousal) and ensure
strategies appropriate at different points in the cycle that team is able to provide appropriate support as outlined
in BSP
The importance and knowledge of signs of stress and anxiety within
the team Implement crisis/emergency procedures according to
protocol
Why it may be beneficial to change staff rotas - for example to
alleviate staff stress and the potential negative impact of this. Ensure that any physical or psychology contraindications to
physical intervention are assessed on an individual user basis
The importance of aftercare for staff and people being supported
Ensure that team is able to and support the implementation
Ethical reactive strategies and how they should be implemented of ethical reactive strategies. Ensure the correct paperwork
is completed
The recording and reporting process
Change rotas appropriately, provide extra supervisions,
check incident reports completed, is physically present
Implement person centred aftercare strategies for example,

medical and emotional wellbeing and debriefing for person
being supported and staff
Access additional support from outside own direct team to

support during crisis in a timely manner
Reflect on and support others to reflect on personal

experience when implementing reactive strategies;
debriefing is offered
ORG/ The importance of using least restrictive crisis management Clear policy on the use of restrictive practices
CST procedures
Ensure the delivery of accredited, effective theoretical and
The ethical and practical implications of using reactive strategies practical training in line with this policy
58
The importance of investigating unplanned restrictive incidents Establish an infrastructure and allocate the resources
needed to support a least restrictive management strategy
The current legal and ethical framework and how to implement
nationally agreed standards of best practice within organisation Ensure a least restrictive crisis management strategy is in
place for each person that is appropriate and congruent with
accredited training; address concerns for any proposed
strategies that might not be practical; ensures that least
restrictive strategies are understood by all members of the
team
Encourage discussion around ethical and practical

implications of reactive strategies; support staff at all levels
to understand these issues
Routinely monitor restrictive practices (e.g. for an individual

and across the organisation) for trends and variances
Investigate unplanned restrictive interventions and

maintains paperwork trail to ensure it was legally and
ethically appropriate; redesign systems and programmes
accordingly
Establish mechanisms and skilled workers to ensure

debriefing occurs and staff support in place
Review debriefing data regularly and devises and ensures

action plan is implemented to address recommendations
including need for further training, change to processes and
procedures etc.
Ensure that restrictive interventions are delivered within an

overall organisational framework that actively seeks to
reduce their use to a minimum.
59
3.6 Developing the plan; outlining responsibilities and timeframes
DC That for each BSP : Check understanding of role and responsibilities within the Research shows that
 Someone is responsible for each element of the plan and it BSP and question anything that is not fully understood progress is more likely
must be implemented consistently when each element of
 Own role in relation to the responsibilities outlined within Be supportive to colleagues to understand the plan, the BSP clearly states
the plan especially new staff who is responsible
 The rationale for the plan and key functions of behaviour (Chaplin et al., 2014)
that challenges identified for the person Highlight any misunderstandings or difficulties in
 The short, medium and long terms aims of the plan implementation to supervisor
SUP/ Responsibilities outlined within the plan of own role and the role of Know the plan in detail and communicates key strategies
MGR supervisees and reasons why they are needed. Describe the short,
medium and long term goals of the plan
That key stakeholders, as well a staff, need to know and understand
the BSP Check individual team members’ understanding of their
respective roles and responsibilities within the BSP and
address any misunderstandings
Organise resources (e.g. rotas) to ensure that a plan can be

followed within the appropriate timeframes
Record any variance (e.g. if teaching strategy has not been

introduced at point in time), and establish response to
rectify the issue
If necessary, seek further support from senior managers for

resource issues or performance management
Ensure information is readily available to staff, kept

updated, written in straightforward language and support
team members to understand key issues and to share
information as appropriate
60
ORG/ Importance of multi-disciplinary working and the need to include Ensure staff are trained in or have access to, specialist
CST everyone who is supporting a person in the BSP; to know their behavioural skills, in order to write high quality plans based
respective roles and responsibilities and to understand the on accurate assessment data
timeframes involved
Ensure an agreed format is used and mechanisms are in
The evidence base behind the reasons why everyone who has direct place to review BSP regularly
contact with an individual needs to have a detailed knowledge of
that person’s BSP. Ensure, that within a multi-disciplinary approach, all
stakeholders understand their respective roles and
responsibilities within the BSP and address anything that is
not fully understood
3.7 Monitoring the delivery of the BSP (procedural/treatment fidelity/integrity)
DC The importance of ensuring the BSP is implemented as intended Identify the possible outcomes of failing to adhere to the Emerging research
BSP – e.g., increase challenging behaviour, prevent the findings have
Ways of monitoring the extent to which the BSP is implemented as person learning skills, not help the person to have a better demonstrated a positive
intended quality of life relationship between
treatment integrity and
Reflect on own practice, and that of other team members intervention outcome.
and try to ensure that everyone follows the plan properly Fiske (2008) and such
(ensure integrity of practice) associations have been
Monitor and report changes in challenging behaviour, found in other areas of
acquisition of skills such as communication, participation in psychoeducational
activities and other quality of life indicators intervention
Complete records and other documents that help describe

or monitor the implementation of the BSP
61
Identify and Report obstacles to successfully delivering the
BSP (e.g. a new team member who does not understand a
strategy, part of BSP out of date etc)
Provide feedback on what worked well and what could have

worked better
Regularly attend and actively participate in supervision and

review meetings
SUP/ The importance of ensuring the BSP is implemented as intended, Teach direct carers why adhering to the BSP is important.
MGR including the implications of poor adherence
Explain possible long terms implications, such as how failing
The importance of an integrated performance monitoring and to ensure high levels of procedural integrity can result in
quality assurance system challenging behaviour, poor quality of life and repeated,
unnecessary revisions to the BSP (i.e. people mistakenly
What ‘positive monitoring’ means think the BPS is the problem)
How to summarise and analyze delivery monitoring data Check records are completed accurately
How to present delivery monitoring data in a visual format Undertake regular and frequent positive monitoring
observations
How to operate and design customized Periodic Service Review
schedules Summarise and analyse monitoring data and use this to
regularly discuss and feedback to the team e.g. presenting it
visually as graphs etc. on the effectiveness of the BSP
Use computer software to analyse and present delivery

monitoring data in a visual formats
Provide feedback to supervisees and stakeholders on what

worked well and what could have worked better
Incorporate the above monitoring, feedback and review

systems into whatever overarching performance
management quality assurance systems is in use (e.g. PSR)
62
ORG/ Data driven procedural integrity reflects a more scientific or Ensure that there are organisation wide systems for
CST effective approach to assessing the effectiveness of an intervention; monitoring the delivery of BSPs in place and are utilised
and is the only way to be sure that the strategies outlined in the BSP within the organisations performance management and
are implemented or not quality assurance systems.
How to design and implement delivery monitoring systems Select or design delivery monitoring systems and train direct
carers in their use
3.8 Evaluating the effectiveness of the BSP
DC The importance of evaluating the effects of a BSP in terms of all Describe the goals of the BSP as they relate to all relevant The strategies contained
relevant outcome variables: outcome variables e.g. why measure changes in challenging within the BSP need to
behaviour? be reviewed to check
 Reductions in challenging behaviour they are having the
 Increases in functional communication Gather data on outcome variables using agreed systems desired effect, continue
 Acquisition of new skills to be acceptable to the
 Participation in activity Report progress and identify the factors that facilitate person and key
 Decreases in the use of restrictive practices (including, but progress stakeholders and are
not limited to, physical restraint) feasible, given the time
Report lack of progress or obstacles to achieving outcomes and effort needed.
Data gathering methods to support evaluation
SUP/ The importance of evaluating effectiveness Explain the rationale for evaluating a given outcome variable
MGR and link this to the PBS model
The different ways in which outcomes variables can be measured
Select or design appropriate measures that evaluate
How to summarise and analyse outcome data outcome variables (e.g., individualised frequency charts,
record of physical interventions used)
How to present outcome data in various formats including visually
(e.g., using graphs) Train direct carers in the use of the data gathering methods
63
Ensure the continued competence of direct carers in the use
of the data gathering methods
summarise and analyse outcome data and present in visual

format, (e.g. using computer software such as Excel)
Provide data on the effectiveness of the BSP in visual format

(graphs)
ORG/ The importance of practice being evidence-based at the an Explain why, in addition to being evidence-based in terms of
CST Individual, group of individuals , and organisational level , and that using empirically supported methods, we must also evaluate
the only way to assess effectiveness is through systematic what works for the person and what works at a group and
monitoring and evaluation at each level organisational levels and how to monitor outcomes
organisation-wide
The different outcomes variables that can be measured at an
Individual, group of individuals , and organisational level Select or design appropriate measures that evaluate
outcome variables at an Individual, group of individuals ,
How to analyse outcome data at an Individual/ group of individuals and organisational level (e.g., physical aggression and self-
and organisational level injury, along with use of physical interventions)
The importance of the periodic auditing of systems and procedures Ensure that there are organisation wide systems for
across the organisation evaluating outcome data at an individual , group and
organisational level in place and are utilised within the
organisations performance management and quality
assurance systems
Implement periodic audits of systems in place across the

organisation
64
3.9 The BSP as a live document
DC The BSP is a live document, and should be evaluated and adapted in Actively participate in review meetings The BSP is effectively a
light of ongoing data on key outcomes strategy outlining how to
Address any inconsistencies in the delivery of the BSP both best support a person. As
in own practice and supporting others that person’s behaviour
changes the BSP needs to
Follow through on any changes to the BSP made in light of change with them,
the monitoring and evaluation procedures therefore regular reviews
and updates are
necessary.
SUP/ The cycle of assessment, intervention, monitoring and evaluation, Address any inconsistencies in the delivery of the BSP and
MGR with particular emphasis on the outcome variables relevant to the ensure that all members of the team understand the
PBS model measures taken
The BSP is a live document, and the need to translate on-going data Change or adjust elements of the BSP based on the
into actions aimed at achieving the existing goals of the BSP, or how evaluation data gathered and ensure that all members of the
on-going data can be incorporated into adapting the goals of the team understand the measures taken
BSP
Make clear the link between the data collected and the
How to make, and facilitate the making of, data-based decisions decision making process and ensure that the team
understand this relationship
How to effectively chair review meetings
Ensure, when chairing a review meeting, that all
stakeholders have their say, that timings are observed, that
appropriate data are used to inform all decisions, and that
all necessary areas are covered, such as:
 What has been tried (description of BSP)
 What worked (includes visual feedback)
 What did not work (includes visual feedback)
 What do we do next (action setting)
65
Incorporate the above monitoring, feedback and review
systems into whatever overarching performance
management quality assurance systems is in use (e.g. PSR)
Ensure that the most up to date version of the BSP is

available and used by staff
ORG/ The infrastructure and processes that need to be in place in order to Ensure that the resources and infrastructure are in place so
CST support the cycle of assessment, intervention, monitoring and that the cycle of assessment, intervention, monitoring and
evaluation, with particular emphasis on the outcomes variables evaluation occurs
relevant to the PBS model
66
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Acknowledgements
The development of this framework came about as a follow up of the International Journal of Positive Behavioural Support (IJPBS)
special edition, 2013 (volume 3, 2) which sought to provide a definition and clarification of Positive Behaviour Support (PBS)
appropriate to the UK health and social care system.
Skills for Care kindly agreed to host and fund 3 workshops which brought together a mix of PBS practitioners and academics to
write the content. Stakeholder workshops to review progress were held with the Challenging Behaviour National Strategy Group
and the Challenging Behaviour Community of Practice (Wales).
The following individuals have given up time to contribute to the development of these competencies:
Workshop contributors
Heather Armstrong Jill Chaplin Freddy Jackson Brown Marie Lovell Sarah Wakeling
Nick Barratt Louise Denne Katy Lee Darren Parnell Marianne Wooldridge
Jonathan Beebee Jon Hull Gill Legg Jo Pyrah
Editing group*32
David Allen Richard Hastings Peter McGill
Peter Baker Carl Hughes* Steve Noone*
Nick Gore* Edwin Jones* Sandy Toogood
32
Also attended Workshop/s
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Positive Behavioural Support

Positive Behavioural Support (PBS)

The Framework is available on the PBS Academy website: www.pbsacademy.org.uk

What is Positive Behavioural Support (PBS)? 6

Why use PBS? 10

How is PBS implemented? 12

What is the PBS Competence Framework? 13

The PBS Competence Framework

Creating high quality care and support environments 20

How is PBS implemented?

PBS may be implemented in at least three ways:

 The Behaviour Specialist/Supervisory/Managerial and Higher Level Behaviour Specialist/Organisational/Consultant

Case/risk complexity requires specialist

Higher Level Behaviour

1.1 Ensuring that services are values led

Minimise any restriction of activities or movement; and use positive

Provide positive feedback on staff performance related to their

Recruit team members with appropriate values and attitudes

Review and discuss team members’ attitudes regularly and support

Role model dignity, respect, warmth, empathy, compassion in

Actively manage staff and the environment to build a positive

1.2 Knowing the person

SUP/ The importance of person-centred planning Liaise with circle of support

Schedule the implementation of and measure progress towards

Check that implementation balances across areas of life, type of

Declare any personal and/or professional relationships that will or

Attend to own physical, psychological and emotional wellbeing

Lead and model the implementation of PBS in practice (i.e. practice

Clarify staff roles in practice, and promote team work

Organise regular Periodic Service Review (PSR) and ensure

Facilitate regular team meetings to review and update support plans,

Provide frequent and regular feedback to individuals and the team as

1.5 Supporting communication

Contribute to the development of a detailed description of how best

Demonstrate appropriate communication methods at team meetings,

Ensure team members know the assessed communicative function of

Support staff in the understanding of more complex systemic

Support assessment and intervention components that address

1.6 Supporting Choice

How to support the team to present and help a person

1.7 Supporting physical and mental health

Ask senior manager or clinician for support/advice when needed

The management of any specific condition relevant to the

The risk of over-medicating

Basic first aid

Who to contact for additional guidance on how to support

Support access to any additional professional help and to rapidly

Design and support the implementation of a programme to enable a

Monitor the safety, consistency and predictability of environments

Influence and change the system of support if it does not produce a

Measures participation and community involvement as outcomes and

Designs interventions that enable persons to develop new skills and to

Safeguarding procedures in the work place

Contact appropriate people to involve them in capacity assessments

Ensure that policies and procedures feed into service philosophy

Develop a culture in which it is safe to report

1.12 A commitment to Behaviour Skills Training

Use the behaviour skills training approach when teaching staff

Conduct training audits, identify gaps in staff knowledge and deliver

2.1 Working in partnership with stakeholders

Who the key stakeholders are for each person supported

Coordinate and ensure immediate resources are available to

Raise resource issues and needs on an organisational level